Osteoarthritis of the hip: symptoms, treatment and prevention

The hip joint is the largest joint in our body. It has a hinge configuration that allows movement in various planes. At the same time, the joint is surrounded by strong ligaments and muscles. The hip joints take the main load when walking, running, and weight bearing. Coxarthrosis (another name for osteoarthritis of the hip joint) is quite common in the elderly and young. Having started, it can go undiagnosed for a long time, since the visible limitation of hip movements does not immediately occur.

Often, patients, without having been examined by a doctor or having declared all complaints, begin to treat lumbosacral osteochondrosis or osteoarthritis of the knee joints with no visible effect. During this time, the untreated disease progresses and results in lameness, constant pain, shortening of the leg, and the inability to do flexion-extensions. And treatment at this stage is possible only operatively, that is, the joint needs to be replaced.

Causes of coxarthrosis

healthy joint and osteoarthritis of the hip

Primary osteoarthritis of the hip joint develops more often in people over 40 years of age. Its causes have not yet been studied. Hyaline cartilage, which covers joint surfaces and provides sliding, begins to thin and break down. Due to the increased friction and pressure on the bones, bone growths appear on them. The joint is deformed, movement is limited. In primary coxarthrosis, the knee joints and the spine are often affected.

Secondary osteoarthritis develops against the background of various diseases:

  • Hip joint dysplasia. This term refers to the congenital underdevelopment of the components of this joint in a child. As a result, the femoral head is not properly centered in the acetabulum. Three types of dysplasia are possible: preluxation, subluxation and dislocation of the hip. With congenital dislocation, the femoral head is outside the cavity, and if proper treatment is not carried out, osteoarthritis develops in the future.
  • Aseptic necrosis. The bone tissue of the femoral head begins to dissolve due to a violation of the blood supply. Bone tissue dissolves focal, the head of the joint is deformed. Osteoarthritis develops for the second time.
  • Legg-Calve-Perthes disease. This is osteochondropathy of the femoral head, which occurs in children aged 3 to 14 years, mainly in boys. It usually occurs due to complications after infectious processes, as well as injuries, physical overload, metabolic diseases. The cartilaginous area of the head is not well supplied with blood, which leads to necrosis of this area and deformation of the joint.
  • Inflammation, infection. If arthritis of the hip joint develops, the synovial fluid loses its lubricating properties, the joint shell thickens, the hyaline cartilage is exposed to mechanical stress, and metabolic disturbances in the joint occur. produce at the same time.
  • Injuries: bruises, fractures of the hip, acetabulum, dislocation of the hip, chronic trauma, that is to say microtrauma received systematically.
  • Overload of the hip joint associated with sports, professional activities. For example, it is undesirable for the joint to walk without rest for a long time, the effects of vibration, constant jumping, carrying heavy loads. The muscle corset of a child or adolescent cannot always compensate for such loads.
  • Increased body weight, especially at a young age, when the cartilage is not yet able to support a large axial load. In addition, these patients usually have metabolic problems.
  • Coxarthrosis itself is not inherited, but genetically parents can have a certain structure of cartilage tissue, metabolic disorders that lead to the development of osteoarthritis. Therefore, the presence of joint diseases in relatives or more distant relatives should be considered.
  • Osteoporosis. The vulnerable area in this disease is the femoral neck. Its structure becomes rare, pathological fractures are possible. All of this again leads to osteoarthritis.
  • Diabetes. In this case, osteoarthritis develops due to vascular disorders.
  • Polyneuropathy with altered sensitivity of the legs.
  • Diseases of other parts of the musculoskeletal system. These include: scoliosis, osteoarthritis and knee injuries, flat feet. The load distribution on the hip joints changes, the shock absorption properties decrease, as a result the cartilage lining suffers.

Symptoms of coxarthrosis

pain in the hip joint with osteoarthritis

For the prevention of the disease and its early diagnosis, it is important to know the signs of incipient osteoarthritis of the hip joint (coxarthrosis of the 1st stage):

  • Pain that periodically occurs after physical exertion. Specific painful sensations can be localized in the groin area, side, thigh, or knee. After rest they pass, so they do not receive any importance. In the meantime, this is an alarming sign.
  • Slight limitation of hip rotation (inward and outward). This is easily checked by lying on your back turning your entire leg clockwise and counterclockwise.
  • On the roentgenogram, you can find a slight, uneven narrowing of the joint space.

With second stage osteoarthritis, the signs are more pronounced:

  • Pain occurs in the projection of the joint, more often in the inguinal fold, and is noted at rest.
  • The restrictions appear not only when rotating the leg, but also when abducting the hip to the side. Movements in the joint are somewhat painful, especially in extreme positions (with maximum hip abduction, flexion of the leg towards the stomach).
  • On the x-ray, you can see moderate narrowing of the joint space and unique bony growths from the edges of the acetabulum. Cysts can also form in the bone structure of the femoral head.

Stage 3 osteoarthritis of the hip is easily diagnosed, its symptoms are pronounced:

  • Joint pain on exertion at night.
  • Lameness, often patients use a cane.
  • Pronounced limitation of movement in the joint, as a result of which it is difficult for a person to put on socks on his own, to put on shoes.
  • The leg becomes thinner due to the hypotrophy of the muscles of the thigh and lower leg. The muscles in the gluteal region also weaken.
  • It is possible to shorten the leg due to its incomplete extension and deformation of the femoral head. As a result, scoliosis of the lumbar spine (lateral curvature) is formed, pain appears in the lumbosacral region.
  • Signs of the 3rd stage, detected by x-ray, are a pronounced narrowing of the joint space until its complete absence, bone growths, deformation of the head and neck of the hip joint.

Diagnostic

In the diagnosis, it is of great importance to clarify subjective complaints, collect the anamnesis, assess the symptoms, and also clarify the stage - x-ray, computed tomography and MRI. Computed tomography allows you to study the bone structure of the hip joint in detail, and the magnetic resonance method visualizes soft tissue, the condition of the joint capsule and the presence of synovitis.

Processing

Treatment for coxarthrosis depends on the stage of the process and, in most cases, includes a whole range of procedures. Of course, the earlier the treatment is started, the greater its effectiveness.

  1. Conservative treatment
    • Drug therapy.To relieve pain, nonsteroidal anti-inflammatory drugs are used in the form of tablets, suppositories or intramuscular injections. Dosage forms such as ointments, gels and creams are not effective enough due to the surrounding of the hip joint with large muscles and subcutaneous tissue. Long-term treatment with nonsteroidal anti-inflammatory drugs is not recommended due to side effects on the cardiovascular system and gastrointestinal tract. To help them, the doctor may prescribe drugs that relieve muscle spasms - a muscle relaxant. In severe inflammation, intra-articular glucocorticoids may be needed. Chondroprotectors are one of the main groups of drugs for the treatment of hip osteoarthritis. They are administered both intramuscularly and intra-articularly; in milder cases, tablet forms can be taken. These drugs are aimed at improving the recovery processes in cartilage tissue, slowing down its degeneration. The doctor may also prescribe vascular drugs to improve local circulation.
    • Physiotherapy.Its procedures improve blood circulation in the joint area and relax muscles. These are UHF, magnetotherapy, laser therapy, diadynamic currents, electrophoresis. Appointment - according to individual indications.
    • Massage therapy.An indispensable method of treatment for coxarthrosis: relieves muscle spasms, has a beneficial effect on blood circulation and, if carried out systematically, strengthens muscles.
    • Physiotherapy.Improves blood circulation and strengthens the muscle corset of the joint. Recommended exercises for hip osteoarthritis (performed on a solid support):
      • "Bike" in the supine position;
      • lying on your back, grab your knee with your hand and pull it towards your stomach, as well as your other leg;
      • in a lying position, bend the knees, press the plants to the ground and lift the pelvis, linger in this position;
      • lying on your back, spread your thigh as far as possible;
      • sitting on a chair, squeeze the ball between your thighs;
      • lying on your back, turn your legs in and out;
      • Standing with your right foot on a small elevation and holding the stand with your hands, swing your left leg back and forth and left to right, then do the same while changing legs.
  2. Operative treatment. . . The endoprosthesis, that is to say the replacement of a joint by an artificial joint, is carried out in the 3rd stage of coxarthrosis in the presence of shortening of the limbs, constant pain, severe contracture. Stents can be cemented (in the presence of osteoporosis) and uncemented. The prosthesis itself is unipolar (replacement of the head only) and total (replacement of the two components). Already the day after the operation, some elements of exercise therapy are carried out while lying in bed, the patient can get up, but so far without support on his leg, after a few days - with crutches. After 2-3 months, crutches will no longer be needed, a full load on the leg will be allowed. Patients who have undergone a stent are recommended to rehabilitate, which consists of physiotherapy exercises, massage course, physiotherapy. In most cases, limb function is restored. The service life of the prosthesis is 10-20 years, then it is replaced with a new one.

Prevention of coxarthrosis

Preventive measures are very important, especially if you have a history of hip dysplasia, fractures, severe bruising or purulent processes in this area.

  • Exclusion of weight transfer, jumps (especially from a height). Try not to stand for long.
  • Weight control (reduce the consumption of flour products, table salt, sweet tea and strong coffee in the diet). If you are overweight, the risk of osteoarthritis of the hip joint increases.
  • Dosage physical exercises aimed at strengthening the muscles of the thighs and buttocks (cycling or stationary bike, swimming, therapeutic exercises).
  • If there are metabolic diseases (diabetes mellitus, atherosclerosis), they must be compensated.

Compliance with preventive measures, early detection of coxarthrosis and its adequate treatment are the key to a positive prognosis for this disease.

Which doctor to contact

If you experience pain in your leg or hip, you should see a therapist. He will order the primary diagnostic measures, in particular an X-ray of the hip joint. Once the stage of development of the disease is established, the patient will be referred to a rheumatologist or orthopedist. A dietitian and an endocrinologist can provide additional help in reducing weight and slowing the progression of the disease. It will be useful for women to consult a gynecologist for the appointment of hormone replacement therapy for the prevention of osteoporosis.